Wiki Billing E/M visits 1-3 from OB Flow Sheet

[megore]

Does anyone have information about billing E/M codes for prenatal care when a patient has 1-3 visits using the ACOG OB Flow sheet? I am having a problem getting an adequate HPI . The exam and decision making are there, but there is not a place for the HPI on the flow sheet. Any suggestions or help would be appreciated.

 

[leloisa@uci.edu]

Are you charging this patient out because she transferred care to a different provider?

 

[megore]

Yes, the patient is leaving the practice. Sometimes this happens to if they change insurance carriers

 

[DamaraA]

When billing out prenatal care, you are going to use established E/M codes anyway, which only require 2 of the 3 elements. So if you have exam and medical decision making, you will not need HPI. Regarding the level of code, if you only have what is written on the flowsheet, with no additional documentation or chart note, it will most likely only qualify for a 99212. If your initial visit wasn't already billed out as an E/M, you can select that level based on their new patient exam and documentation. Make sure you know the requirements of your payer. Some payers want it done a specific way; for example, Colorado Medicaid requires a modifier TH added to any antepartum visits that don't qualify for global or the antepartum care codes (59425 and 59426.) Other payers may have requirements regarding the initial visit. Some commercial payers will only pay the initial visit with a specific dx code (like V72.42.) Some may deny the initial visit, or all E/M visits as inclusive to global, which would require an appeal. You may choose to submit a hard copy claim stating that patient transferred, in order to avoid the denial. Hope that helps.